Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

Abstract

Laparoscopic resection for colon and rectal cancer is associated with quicker return of bowel function, reduced postoperative morbidity rates and shorter length of hospital stay compared to open surgery, with no differences in long-term survival. Conversion to open surgery is reported in up to 30% of patients enrolled in randomized control trials comparing open and laparoscopic colorectal resection for cancer. In this review, reasons for conversion are anatomical-related factors, disease-related-factors and surgeon-related factors. Body mass index, local tumour extension and co-morbidities are independent predictors of conversion. The current evidence has shown that patients with converted resection for colon cancer have similar outcomes compared to patients undergoing a laparoscopic completed or open resection. The few studies that have assessed the outcomes after conversion of laparoscopic rectal resection reported significantly higher rates of complications and longer length of hospital stay in converted patients compared to laparoscopically treated patients. No definitive conclusions can be drawn when converted and open rectal resections are compared. Early and pre-emptive conversion appears to have more favourable outcomes than reactive conversion; however, further large studies are needed to better define the optimal timing of conversion. With regard to long-term oncologic outcome, overall and disease-free survival in the case of conversion in laparoscopic colorectal cancer surgery seems to be worse than those achieved in patients in whom resection was successfully completed by laparoscopy. Although a worse long-term oncologic outcome has been suggested, it remains difficult to draw a proper conclusion due to the heterogeneity of the long-term outcomes as well as the inclusion of both colon and rectal cancer patients in most of the studies. Therefore, we discuss the currently available evidence of the impact of conversion in laparoscopic resection for colon and rectal cancer on both short-term outcomes and long-term survival.

Short-term outcomes after elective colon cancer surgery: an observational study from the Norwegian registry for gastrointestinal and HPB surgery, NoRGast

“…The readmission rate of 9.8% is not exceeding readmission rates in reports with longer primary LoS [22,23] and hence seems acceptable, reflecting an overall reasonable discharge policy. The conversion rate of 10.2% of all commenced laparoscopy is in line with recent reports from other unselected cohorts [24,25].…”

Is Conversion from Laparoscopic to Open Surgery in Colorectal Cancer Predictable in the Preoperative Period?

“…[2] Various studies have shown that the need to convert from laparoscopic to open surgery may emerge due to factors, such as advanced age, high ASA class (≥III or IV), high BMI, male gender, history of abdominal surgery, local advanced neoplasia, middle and lower rectal cancers, and complicated diverticulitis. [1,4,10,11] In the current study, BMI was ≥28 in most of the patients that required open surgery conversion, with male gender, age and tumor invasion being present at lower rates in this group. Among the reasons for conversion, difficulty of exploration and history of surgery were more frequent.…”

“…Studies suggest that BMI, local tumor invasion, and comorbidities are independent risk factors of conversion to open surgery. [4] In the literature, it has been reported that the conversion rate is increased in cases above 65 years, those with a BMI of ≥28, male patients, and in the presence of tumor invasion. [2] Various studies have shown that the need to convert from laparoscopic to open surgery may emerge due to factors, such as advanced age, high ASA class (≥III or IV), high BMI, male gender, history of abdominal surgery, local advanced neoplasia, middle and lower rectal cancers, and complicated diverticulitis.…”

“…In a randomized controlled trial, conversion from laparoscopic to open surgery in colorectal cancer was reported to be approximately 30%. [4] Anatomical, patient-related and surgeon-related factors have been suggested as the reasons for such conversion requirement. [5,6] In the current study, the conversion rate was found to be 23%.…”

Mucinous carcinoma is a predictive factor for the risk of open conversion from laparoscopic colectomy in colorectal cancer

“…We found that the most frequent reason for conversion was invasion of cancer to adjacent tissues or organs, which accounts for nearly 50%. Allaix et al [16] reviewed all literature on cases of open conversion during laparoscopic resection for both colon cancer and rectal cancer for all years up to March 2016, and the most frequent reasons for conversion were also cancer-related factors. The other causes they reported were adhesion, obesity, or anatomic-related factors, which were similar to the results of our study.…”